Back Problems and Injuries

Topic Overview

Most people will have a minor
back problem at one time or another. Our body movements usually do not cause
problems, but it's not surprising that symptoms develop from everyday wear and
tear, overuse, or injury. Back problems and injuries often occur during sports
or recreational activities, work-related tasks, or home projects.

Back pain can cause problems anywhere from the neck to the
tailbone (coccyx). The back includes:

Back injuries are the most common cause of back pain.
Injuries frequently occur when you use your back muscles in activities that you
do not do very often, such as lifting a heavy object or doing yard work. Minor
injuries also may occur from tripping, falling a short distance, or excessive
twisting of the spine. Severe back injuries may result from car accidents,
falls from significant heights, direct blows to the back or the top of the
head, a high-energy fall onto the buttocks, or a penetrating injury such as a
stab wound.

Although back pain is often caused by an injury to one
or more of the structures of the back, it may have another cause. Some people
are more likely to develop back pain than others.
Things that increase your risk for back pain and
injury include getting older, having a family history of back pain, sitting for
long periods, lifting or pulling heavy objects, and having a degenerative
disease such as
osteoporosis.

Slumping or slouching alone may not cause low back pain. But after the back has been strained or injured, bad posture can make pain worse. "Good posture" generally means your ears, shoulders, and hips are in a straight line. If this posture causes pain, you may have another condition such as a problem with a disc or bones in your back.

Low back pain may occur in
children and teenagers , but children and teens are
less likely to see a doctor for low back pain. Although most back problems
occur in adults ages 20 to 50, back problems in
children younger than 20 and adults older than 50 are more
likely to have a serious cause.

Sudden (acute) injuries

Pain from an injury may be
sudden and severe. Bruising and swelling may develop soon after the injury.
Pain from an acute injury usually does not last longer than 6 weeks. Acute
injuries include:

An injury to the ligaments or muscles in the
back, such as a
sprain or a
strain.

A fracture or dislocation of the
spine. This can cause a spinal cord injury that may lead to permanent
paralysis. It is important to immobilize and transport the injured person
correctly to reduce the risk of permanent paralysis.

A torn or
ruptured disc. If the tear is large enough, the jellylike material inside the
disc may leak out (herniate) and press against a nerve. See a picture of a
herniated disc.

Overuse injuries

You may not remember a specific injury,
especially if your symptoms began gradually or during everyday activities.
These injuries occur most often from improper movement or posture while
lifting, standing, walking, or sitting, or even while
sleeping. Symptoms can include pain, muscle spasms,
and stiffness. The pain often goes away within 4 weeks without any
treatment.

Some
medical conditions can cause pain to spread to the
back from other parts of the body (referred pain). Many health problems that
can cause back pain have nothing to do with the bones, joints, muscles, or
ligaments of the back.

Chronic pain syndrome caused by a previous injury or
degenerative disease with aging can cause back pain.

Treatment

Most back pain will get better and go away
by itself in 1 to 4 weeks. Home treatment will often help relieve back pain
that is caused by minor injuries. It is usually a good idea to continue your
regular activities while your back is healing. Avoid heavy lifting and
activities that seem to make your back problems worse.

Other
treatments for a back problem or injury may include first aid measures,
physical therapy, manipulative therapy (such as chiropractic), medicine, and, in
some cases, surgery. Treatment depends on:

Severe pain (8 to 10): The pain
is so bad that you can't stand it for more than a few hours, can't sleep, and
can't do anything else except focus on the pain.

Moderate pain (5 to 7): The pain is bad enough to disrupt your
normal activities and your sleep, but you can tolerate it for hours or days.
Moderate can also mean pain that comes and goes even if it's severe when it's
there.

Mild pain (1 to 4): You notice the pain,
but it is not bad enough to disrupt your sleep or activities.

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

Severe pain (8 to 10): The
pain is so bad that the baby cannot sleep, cannot get comfortable, and cries
constantly no matter what you do. The baby may kick, make fists, or
grimace.

Moderate pain (5 to 7): The baby is
very fussy, clings to you a lot, and may have trouble sleeping but responds
when you try to comfort him or her.

Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds
when you try to comfort him or her.

Pain in children 3 years and older

Severe pain (8 to 10): The pain
is so bad that the child can't stand it for more than a few hours, can't sleep,
and can't do anything else except focus on the pain. No one can tolerate severe
pain for more than a few hours.

Moderate pain (5 to 7): The pain is bad enough to disrupt the child's normal activities and
sleep, but the child can tolerate it for hours or days.

Mild pain (1 to 4): The child notices and may complain of the pain,
but it is not bad enough to disrupt his or her sleep or activities.

Major trauma is any event that can
cause very serious injury, such as:

A fall from more than
10 ft (3.1 m) [more than
5 ft (1.5 m) for children under
2 years and adults over 65].

A car crash in which any vehicle
involved was going more than
20 miles (32 km) per
hour.

Any event that causes severe bleeding that you cannot
control.

Any event forceful enough to badly break a large bone (like an arm bone or leg bone).

With severe bleeding, any of these may
be true:

Blood is pumping from the wound.

The
bleeding does not stop or slow down with pressure.

Blood is quickly soaking through bandage after bandage.

With moderate bleeding, any of these may
be true:

The bleeding slows or stops with pressure but
starts again if you remove the pressure.

The blood may soak through
a few bandages, but it is not fast or out of control.

With mild bleeding, any of these may be
true:

The bleeding stops on its own or with
pressure.

The bleeding stops or slows to an ooze or trickle after
15 minutes of pressure. It may ooze or trickle for up to 45 minutes.

Urinary tract infections may occur in
the bladder or kidneys. Symptoms may include:

Pain or burning when you urinate.

A frequent need to
urinate without being able to pass much urine.

Pain in the flank, which is either side of the back just below the
rib cage and above the waist.

Blood in the
urine.

Fever.

Shock is a life-threatening condition that may quickly occur
after a sudden illness or injury.

Symptoms of shock (most of which will be present) include:

Passing out (losing consciousness).

Feeling very dizzy or
lightheaded, like you may pass out.

Feeling very weak or having
trouble standing.

Not feeling alert or able to think clearly. You
may be confused, restless, fearful, or unable to respond to questions.

Shock is a life-threatening condition that may occur quickly
after a sudden illness or injury.

Symptoms of shock in a child may include:

Passing out (losing consciousness).

Being very sleepy or hard
to wake up.

Not responding when being touched or talked to.

Breathing much faster than usual.

Acting confused.
The child may not know where he or she is.

Symptoms of a heart attack may
include:

Chest pain or pressure, or a strange feeling in the chest.

Sweating.

Shortness of
breath.

Nausea or vomiting.

Pain, pressure, or a
strange feeling in the back, neck, jaw, or upper belly, or in one or both
shoulders or arms.

Lightheadedness or sudden
weakness.

A fast or irregular heartbeat.

The more of these symptoms you have, the more likely it is that
you're having a heart attack. Chest pain or pressure is the most common
symptom, but some people, especially women, may not notice it as much as other
symptoms. You may not have chest pain at all but instead have shortness of breath, nausea, or a strange feeling in your chest or other areas.

Seek Care Today

Based on your answers, you may need care soon. The
problem probably will not get better without medical care.

Call your doctor today to discuss the symptoms
and arrange for care.

If you cannot reach your doctor or you don't
have one, seek care today.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

Call your doctor now to discuss the symptoms and
arrange for care.

If you cannot reach your doctor or you don't have
one, seek care in the next hour.

You do not need to call an
ambulance unless:

You cannot travel safely either by driving
yourself or by having someone else drive you.

You are in an area
where heavy traffic or other problems may slow you down.

Call 911 Now

Based on your answers, you need
emergency care.

Call911or other emergency services now.

Do not move the person unless there is an immediate threat to the person's life, such as
a fire. If you have to move the person, keep the head and neck supported and in
a straight line at all times. If the person has had a diving accident and is
still in the water, float the person face up in the water.

Call 911 Now

Based on your answers, you need
emergency care.

Call911or other emergency services now.

Put direct, steady pressure on the
wound until help arrives. Keep the area raised if you can.

Call 911 Now

Based on your answers, you need
emergency care.

Call911or other emergency services now.

After you call
911 , the operator may tell you to chew 1 adult-strength (325 mg) or 2
to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.

Urinary Problems and Injuries, Age 11 and Younger

Postoperative Problems

Urinary Problems and Injuries, Age 12 and Older

Pregnancy-Related Problems

Home Treatment

Home treatment may help relieve
pain, swelling, and stiffness related to a back problem.

Return to your normal daily activities and work
as soon as you can, although you may need to modify or limit some work
tasks.

Avoid bed rest. Bed rest is not an effective treatment for
back pain and may cause you to heal more slowly.

There isn't strong evidence that heat or ice helps. But you can try using them to see if they help you.

Try using a heating pad on a low or medium setting for 15 to 20 minutes every 2 to 3 hours. Try a warm shower in place of one session. You can also buy single-use heat wraps that last up to 8 hours.

Change position every 30 minutes. Gently massage or rub the
area to help relieve pain and to encourage blood flow. Do not massage the injured area
if it causes pain.

Avoid sitting up in bed, sitting
on soft couches, and twisting or sitting in other positions that make your
symptoms worse.

Try one of the following
sleep positions if you have trouble sleeping at night:

Lie on your back with your knees bent and
supported by large pillows, or lie on the floor with your legs on the seat of a
sofa or chair.

Lie on your side with your knees and hips bent and a
pillow between your legs.

Lie on your stomach if it does not
increase your pain.

Begin moderate aerobic exercise. Take short walks
(3 to 5 minutes every 3 hours) on level surfaces as soon as you can to help
keep your muscles strong. Avoid hills and stairs. Walk only distances that you
can manage without pain, especially pain in your legs. Add to your exercise
program every week to continue your progress.

Do pelvic tilt
exercises to gently move the spine and stretch the lower back. Lie on your back
with your knees bent and feet flat on the floor. Slowly tighten your stomach
muscles and press your lower back against the floor. Hold the position for 10
seconds. Do not hold your breath. Slowly relax.

More home treatment for a tailbone (coccyx) injury

A warm
sitz bath for 20 minutes, 3 to 4 times per day after
the first 48 to 72 hours, can be soothing to the tailbone area. Sitting in a
hot tub or warm bath may also feel good, as long as you are not sitting
directly on your tailbone.

Do not sit on hard, unpadded
surfaces.

Sit on a C-shaped pillow with the open space under your tailbone to take pressure off the
tailbone area.

Aspirin (also a nonsteroidal
anti-inflammatory drug), such as Bayer or Bufferin

Talk to your child's doctor before switching back and
forth between doses of acetaminophen and ibuprofen. When you switch between two
medicines, there is a chance your child will get too much medicine.

Safety tips

Be sure to follow these
safety tips when you use a nonprescription medicine:

Carefully read and follow all directions
on the medicine bottle and box.

Back pain often gets better when you gradually increase
your physical activity. Try to get back to your normal routines and activities
as soon as possible. Resting and not doing anything may actually increase back
pain or make it last longer.

Work comfort and design

Most back problems that occur
in the workplace are caused by physical stress, such as being in an awkward
position for a long time, making the same motions over and over, and simply
using your back too much. These injuries can cause stress and strain on
muscles, nerves, tendons, joints, blood vessels, or spinal discs.

Arrange your work to help prevent work-related injuries. It is important
to position yourself so that you can sit comfortably and minimize stress on any
one area of your body. Change your positions and tasks as often as possible,
and match tools to your size and preferences. If you are doing a job or task
that requires you to sit for long periods, get up and stretch and move around
at least once an hour.

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